Yang Yanchuan, Ma Xiaojun
People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, 750001, Yinchuan, China.
Department of Orthopaedics, The 942nd Hospital of the Joint Logistics Support Force of the People's Liberation Army of China, Yinchuan, 750000, China.
BMC Surg. 2025 Aug 25;25(1):391. doi: 10.1186/s12893-025-03143-w.
To evaluate the clinical efficacy of one-stage posterior debridement with bone grafting, fusion, and internal fixation in the treatment of Brucellosis Spondylitis.
A retrospective analysis was conducted on 45 patients (30 males and 15 females) with lumbar Brucellosis Spondylitis who met the inclusion criteria and were treated at the Department of Spinal Orthopedics, General Hospital of Ningxia Medical University between January 2010 and February 2025.Patients ranged in age from 30 to 74 years (mean 52.7 ± 10.4 years) and had spinal lesions involving no more than two segments between T12 and S1. All patients received strict oral anti-brucellosis medication before and after surgery, and underwent one-stage posterior debridement with bone grafting, fusion, and internal fixation. Clinical parameters including hospital stay duration, operative time, intraoperative blood loss, and postoperative drainage volume were recorded. Follow-up assessments included Visual Analog Scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores for low back pain, ASIA impairment scale for neurological function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), standard agglutination test (SAT), kyphotic Cobb angle of the affected segments, and postoperative complications such as implant loosening or rod fracture at various time points before and after surgery.
All 45 patients achieved surgical site healed primarily without cerebrospinal fluid leakage or neurological complications. Within one week after the surgery, mild activities (such as standing beside the bed and short-distance walking) can be performed with the aid of a brace to promote blood circulation and prevent complications, with significant improvement in low back pain and neurological symptoms. All patients with preoperative neurological deficits recovered to ASIA grade E by 24 months postoperatively. Significant improvements (P < 0.05) were observed in mean VAS scores, JOA scores, ESR, CRP levels, and Cobb angles at all postoperative time points compared to preoperative values. At final follow-up, all patients demonstrated SAT titers below 1:160. The bone fusion rate reached 91.11% (41/45) according to Bridwell's classification criteria. Based on the modified MacNab criteria, the excellent and good rate was 95.56% (43/45). No cases of disease recurrence, implant loosening, or rod/screw breakage were observed during the follow-up period.
For lumbar Brucellosis Spondylitis, one-stage posterior debridement with bone grafting, fusion, and internal fixation, when combined with standardized pharmacological treatment, represents an effective therapeutic approach. This comprehensive treatment strategy facilitates thorough lesion eradication, improves spinal function, and achieves satisfactory clinical outcomes.
评估一期后路清创植骨融合内固定治疗布鲁氏菌性脊柱炎的临床疗效。
对2010年1月至2025年2月在宁夏医科大学总医院脊柱骨科就诊且符合纳入标准的45例腰椎布鲁氏菌性脊柱炎患者（男30例，女15例）进行回顾性分析。患者年龄30至74岁（平均52.7±10.4岁），脊柱病变累及胸12至骶1不超过两个节段。所有患者在手术前后均接受严格的口服抗布鲁氏菌药物治疗，并接受一期后路清创植骨融合内固定手术。记录临床参数，包括住院时间、手术时间、术中出血量和术后引流量。随访评估包括视觉模拟评分（VAS）、日本骨科学会（JOA）下腰痛评分、神经功能的美国脊髓损伤协会（ASIA）损伤分级、红细胞沉降率（ESR）、C反应蛋白（CRP）、标准凝集试验（SAT）、患节段后凸Cobb角，以及术后不同时间点的术后并发症，如内植物松动或棒断裂。
45例患者手术切口均一期愈合，无脑脊液漏及神经并发症。术后1周内可借助支具进行轻度活动（如床边站立和短距离行走）以促进血液循环并预防并发症，下腰痛及神经症状明显改善。所有术前有神经功能缺损的患者术后24个月均恢复至ASIA E级。与术前相比，术后各时间点的平均VAS评分、JOA评分、ESR、CRP水平及Cobb角均有显著改善（P<0.05）。末次随访时，所有患者SAT滴度均低于1:160。根据Bridwell分类标准，骨融合率达91.11%（41/45）。根据改良MacNab标准，优良率为95.56%（43/45）。随访期间未观察到疾病复发、内植物松动或棒/螺钉断裂病例。
对于腰椎布鲁氏菌性脊柱炎，一期后路清创植骨融合内固定联合标准化药物治疗是一种有效的治疗方法。这种综合治疗策略有助于彻底清除病灶，改善脊柱功能，取得满意的临床疗效。
